While I've never shied away from testing face creams, chemical peels, and lasers—heck, I've even used my own blood as a serum—the prospect of getting injections and undergoing cosmetic surgery has always made me nervous. Thanks to sunscreen, and the rigorous skincare routine I started at the age of 14 (growing up in Australia, a country with a super-thin ozone layer will do that to you), I'm entering my forties with minimal signs of aging.
The one place where I felt my age showed the most, however, was my under-eye area: The lines didn't much bother me, rather, it was the dark, sunken troughs under my eyes that made me look over-tired, even when I was well-rested. So I started thinking about under-eye fillers.
What Are Under-Eye Fillers?
Under-eye fillers are injectable hyaluronic acid treatments (commonly known as Restylane and Juvederm) that can be used to treat volume loss underneath the eyes. The fillers generally last six to nine months and cannot help with hyperpigmentation (i.e., dark circles).
Even though getting dermal fillers is a relatively safe and common practice—and a simple one, too, as injections take mere minutes—I still harbored some major resistance. After some significant soul searching, I realized that much of my hesitation came from how I thought my parents would feel about it and from the shame in telling my husband. I was embarrassed about altering my body in the name of vanity: Why can't I just accept and be happy with the body I was born with? Why do I feel the need to change my appearance to satisfy societal expectations of what it means to be beautiful?
Ultimately though, I decided that this was about me, so I pushed the self-imposed guilt aside. (Getting a teeny bit of filler under my eyes is my choice and no one else's.) So once I finally got past the shame and judgment (which BTW, was all in my head), I booked an appointment with dermatologist Jennifer Herrmann, MD, FAAD, of the celeb-frequented practice Moy, Fincher, Chipps in Beverly Hills.
Meet the Expert
Dr. Jennifer Herrmann is a board-certified, fellowship-trained dermatologist and dermatologic surgeon as well as a lecturer with more than 20 peer-reviewed studies and book chapters.
And as it turns out, everything I thought I knew (and feared) about under-eye fillers was wrong. Here's what I learned.
With Age Comes Bone Loss
As you can see, the areas under my eyes were quite hollow, especially on the right-hand side. According to Herrmann, this hollowing is a result of age-related bone loss around my eye sockets (aka preorbital areas). But, scary as it sounds, it's also super common.
Herrmann breaks down this process over on her practice's blog, where she writes, "Over the age of 35, the number of bone regenerating cells in the face decreases. Gradually, the bone around our eyes widens, leading to eye hollows and flattened cheeks," which results in "a diminished bone scaffold on which our fat and skin sit." As time goes on, wrinkles and folds look more prominent as "our tissues become too large for their underlying bones," she adds. Ultimately, bone loss is a natural part of the aging process, and opting for fillers is a simple, effective way to plump sunken areas.
Consider "Prejuvenation" Fillers
Although age doesn't dictate when you should start getting fillers (rather, it's based on personal preferences), Herrmann described a "prejuvenation" theory I was keen on: "It's much easier to keep a face looking natural by injecting very small amounts of filler slowly over time," she explains, "than to wait until your 50s or 60s and require much larger volumes to restore what time has taken away." I didn't want to drastically change my appearance, but I did like the idea of a slightly enhanced, less sunken version of my face.
Find the Right Doctor
After making the decision to go forward with fillers, Herrmann stresses the importance of finding the right doctor to administer them—and by "doctor," she means a board-certified dermatologist or plastic surgeon (not the aesthetician at a medical spa). "Look for someone with training, experience, and excellent knowledge of facial anatomy," advises Herrmann. "Understanding the exact relationships of facial bones, ligaments, muscles, and facial fat pads is crucial in determining exactly where fillers should be placed for the most natural-looking results—and also minimizes the chances of having severe complications."
Understanding the exact relationships of facial bones, ligaments, muscles, and facial fat pads is crucial in determining exactly where fillers should be placed for the most natural-looking results—and also minimizes the chances of having severe complications.
Talk It Out
During your initial consultation, talk over everything with your doctor—ask all the questions you want, and be sure to discuss any fears.
Write down any questions or concerns and bring them with you! It's easy to get flustered in the moment with doctors and forget to ask something.
Likewise, explain what you're seeing in the mirror, what you'd like to change, and how you'd like to look. "Let your physician know what bothers you and have them walk you through a treatment plan—which may or may not include the use of fillers," says Herrmann. "If your physician understands what you see, it will help them select the most appropriate treatment plan for your goals."
The Process: An Overview
In my case, Herrmann recommended Restylane treatments, but more on that later. Here's what I went through day-of. (Spoiler alert: It didn't hurt a bit.)
Before injecting any fillers, Herrmann first marked my face with a pencil to label the designated areas. She also showed me the (very small) amount of Restylane she would use; it put me at ease knowing the final look would be subtle and natural.
Numbing Cream Followed by the Needle
Herrmann rubbed numbing cream into the marked areas and waited a few minutes for it to work. As she went in with the needle, I could feel the area gradually begin to plump. While administering the filler, Herrmann used her finger to gently push the Restylane into place under the skin. This didn't hurt at all. (I was seriously shocked.)
Time Elapsed: Five Minutes
The whole process was very quick and took less than five minutes. After the injections, Herrmann handed me an ice pack and sent me on my way.
The two needle-entry points are barely visible. But the best part? Zero bruising and no post-procedural pain. However, experts say it's important to remember bruising is completely variable. Sometimes you may not experience bruising, and other times, you will.
Restylane: The Basics
What It Is
"Restylane is a synthetic hyaluronic acid (HA) gel used predominantly for facial rejuvenation," says Herrmann. "The Restylane product family contains multiple fillers that differ in their stiffness and pliability. Some are very soft and fine (like Restylane Refyne) and are excellent for filling fine lines and under-eye hollows, while stiffer, thicker formulations such as Restylane Lyft, are better for lifting cheeks and filling deeper folds."
Is It Safe?
In a word, says Herrmann, yes. "HA is a powerful moisturizing molecule that's naturally found in the skin, which gives it plumpness and youthfulness." Because Restylane is biocompatible with our skin (meaning, it won't harm living tissue) when it's injected, "it integrates without causing an allergic reaction," she adds.
Why Choose Restylane?
"I don't think of one under-eye filler as being "better" than another," explains Herrmann. "There are many types, with distinct uses and certain physical properties." Thus, your doctor might prescribe a different injectable and/or treatment plan, depending on your individual needs.
How Long Will It Last?
"It depends on the filler's properties and how much is injected," says Herrmann. "Stiffer products might last up to two years while lighter products may last closer to six months' time. Your body naturally breaks down HA fillers just as it breaks down native HA, so it gradually disappears in a very natural way."
Filler Myths Busted
You've probably been hearing a lot of talk about under-eye fillers these days. Some of it is undoubtedly true, while other stuff (aka these four common myths) is just a load of malarkey. Here, Herrmann helps separate truth from fallacy.
Myth #1: You must use a lot to get results.
Fact: "Subtle improvements are more natural," says Herrmann, who takes a less-is-more approach. "Results should build slowly, over time," she explains.
Myth #2: All HA fillers are the same.
Fact: Herrmann points out that since "the individual properties of each HA filler make it useful for very specific purposes, results appear most natural. She recommends seeking treatment with a board-certified dermatologist who knows the ins and outs of cutting-edge under-eye fillers.
Myth #3: Fillers smooth areas around the eyes, too.
Fact: If you're hoping to kill several birds with one stone, think again. Crow's feet, and frown lines (including those pesky "elevens"), aren't exactly right for fillers. "Some dynamic lines, like those seen when you're expressing emotions, are better softened with muscle relaxants such as Botox and Dysport," says Herrmann.
Myth #4: Fillers just fill wrinkles and volume loss.
Fact: Nope. According to Herrmann, "Research has shown that in addition to filling, HA fillers also stimulate collagen synthesis by pushing on fibroblasts (the cells responsible for collagen production), triggering them to produce native collagen." Food for thought, indeed.
Three weeks after treatment, I took this makeup-free selfie that shows how my fillers have settled. I look very natural. (So natural, in fact, that no one even noticed I had gotten fillers.) Around this time, many people commented on how good my skin looked—and I'm convinced it's because my under-eye areas were plumper and I no longer looked as tired as I had pre-fillers.
I highly recommend fillers to anyone who's concerned about age-related bone loss and want to freshen up their look: Getting under-eye fillers is a super-simple, painless, and actually a relatively-affordable process at roughly $1,000 per treatment.
I'm so happy I ditched the shame and did something that makes me look and feel so good about myself. I can also happily report that my family members and my husband were incredibly supportive—and they loved the results, too. This whole process has taught me to be confident about how I choose to take care of my own body—it is mine, after all.
Papakonstantinou E, Roth M, Karakiulakis G. Hyaluronic acid: A key molecule in skin aging. Dermatoendocrinol. 2012;4(3):253-258. doi:10.4161/derm.21923
Fan Y, Choi TH, Chung JH, Jeon YK, Kim S. Hyaluronic acid-cross-linked filler stimulates collagen type 1 and elastic fiber synthesis in skin through the TGF-β/Smad signaling pathway in a nude mouse model. J Plast Reconstr Aesthet Surg. 2019;72(8):1355-1362. doi:10.1016/j.bjps.2019.03.032